Many women who home birth their babies report high levels of satisfaction, but controversy remains over their safety.

Photograph by: Christopher Furlong
, Getty Images

Q: My wife really wants a home birth, but my parents are insisting on a hospital. We’re a few months away, but I’m curious. It’s been a healthy pregnancy so far. Are there known advantages to giving birth at home?

A: The popularity of home births varies from country to country. In most developed countries it averages close to one or two per cent. Australia is an exception in that less than one per cent of pregnant women opt for home deliveries. Countries like the Netherlands and New Zealand have a higher rate of home births.

In Canada there is a wide variation between various provinces — home births seem to be the most popular in British Columbia.

Recently there has been an increasing trend toward home deliveries. In part it may be due to the ever-increasing rate of Caesarean sections in Canada; thus fuelling fears of a higher risk of procedures, as opposed to allowing labour to progress on its own.

According to the Society of Obstetricians and Gynaecologists of Canada the incidence of Caesarean sections is climbing. Between 1993 and 2006 Canada’s C-section rate grew to 26.2 per cent from 17 per cent (For home deliveries, the incidence of mothers who end up needing a C section is as low as five per cent).

Women who are not candidates for home deliveries are those who had a previous Caesarean section; women with high blood pressure or pre-eclampsia; diabetic patients; when the membranes ruptured early; a history of a prolapsed umbilical cord; a history of antenatal bleeding; a history of premature deliveries; when the baby is in the breech position; when there are twins; and when the mom has not entered labour by 42 weeks gestation.

Dr. William Sears, an influential pediatrician, author and proponent of attachment parenting, authored The Birth Book in which he explains the many benefits of opting for home deliveries.

Most women who gave birth at home say they will do it the same way if they had to do it over. They like their privacy; they feel they are in control; they can be surrounded by anyone they choose to have in the room; they feel it is more natural; they claim there is less intervention and fewer procedures involving forceps, vacuums and intravenous lines; they also fear that they are more likely to be exposed to infections if they deliver in hospitals.

Proponents of home deliveries claim better pain control, less postpartum bleeding, a lower risk of infections and tears and more success at initiating and maintaining breastfeeding.

They also like the idea that their caregiver comes to them rather than having to figure out when to go to the hospital.

The vast majority of home deliveries are done with the help of midwives. (The term “midwife” means “with woman”). Women who elected to have their deliveries done at home, also tend have a high rate of satisfaction with their midwives whom they deeply trust.

In Canada the profession of midwifery is tightly controlled in terms of maintenance of competence — as opposed to other countries where there is less control and where one may end up with a midwife who may be deviating from the accepted standard of care.

Many midwives in Canada have established a mutually respectful relationship with obstetricians. They know when to ask for help and if there are unexpected acute problems, they are quick to hand over care to those more skilled in reducing the risks of fatal outcomes.

The transfer of care when emergencies arise varies widely between 5 to 40 per cent according to data from the U.K. (See http://goo.gl/YnPxq)

A paper published in the British Journal of Obstetrics and Gynecology in 2009 has more information on the circumstances that led to the transfer of women in labour from home to a hospital to save the lives of both the mother and baby http://goo.gl/X18Au)

Not all doctors share the same enthusiasm for home deliveries. One of the most controversial papers ever published created quite a stir in 2010. It became known as the Wax study, named after the author, Dr. Joseph Wax.

After researching over 500,000 home deliveries the author concluded that it may be safe and beneficial to pregnant women experiencing an otherwise uncomplicated pregnancy, but that for babies born at home there was a three-fold increased risk of neonatal complications.

Currently many experts in the field agree on the need for comprehensive, prospective research to capture not just bad outcomes, but also minor complications along the way. One of the concerns of critics of home deliveries is that there is too much retrospective data. Critics also add that at any time births at home can go wrong and that they want to see more data than just outcome data.

Midwives are quick to distance themselves from so called free birthers. The latter group includes women who want nothing to do with any professionals and who believe that any intervention is akin to legalized rape. For more information on what some call the “extreme beliefs” of free birthers visit www.JoyousBirth.info

Dr. Peter Nieman is a community Pediatrican and the host of www.healthykids.ca. He is the co-founder of the Pediatric Weight Clinic in Calgary and the President of the Alberta Chapter of the American Academy of Pediatrics.

Note: A clarification in statistics from the Society of Obstetricians and Gynaecologists of Canada was made to this story on April 16, 2013.

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